Health watchdog warns NHS trusts are failing to involve families properly during investigations

Two of Sasha Frieze's relatives were treated at the QEH. Picture: Ian Burt

Two of Sasha Frieze's relatives were treated at the QEH. Picture: Ian Burt - Credit: IAN BURT

There are 'system-wide' problems in the way the NHS investigates patient deaths which leave family members in the dark about failures in care, a damning new review has found.

The review by the Care Quality Commission (CQC) highlights how NHS Trusts in England are 'immediately on the defensive' with one family member telling the regulator that they had 'more courtesy at the supermarket checkout' following the death of their loved one.

The health watchdog, which identified a string of problems with the investigation process, visited 12 NHS trusts during the review - including the Norfolk and Norwich University Hospitals NHS Foundation Trust.

Problems identified included a level of 'acceptance and sense of inevitability' when people with a learning disability or mental illness died early.

One parent told the CQC: 'I was put in a room. I shall never forget what the nurse in the room told me. She said, 'You have got to accept that his time has come.' Bearing in mind my son was just 34 years old.'


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Where deaths may have been prevented, NHS Trusts carry out investigations to establish accountability, learn from mistakes and to explain to families what went wrong.

But the CQC said grieving families were not being included or listened to in official investigations into patient deaths.

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They were also left without clear answers as to what happened.

One family member told the CQC: 'You're viewed as a pain in the neck really, it's a bit like if you keep complaining about the washing machine but the machine is out of warranty.

'I've had more courtesy at the supermarket checkout than I've had at the trust.'

Meanwhile, the NHS is also missing opportunities to learn from patient deaths. This means similar tragedies may be repeated in the future, CQC warns.

Not one NHS trust was 'getting it right', the CQC's chief inspector of hospitals Professor Sir Mike Richards said.

Health Secretary Jeremy Hunt is expected to accept all 18 recommendations set out in the report in a speech to the Commons tomorrow.

These include setting a national standard into how NHS trusts investigate deaths and appointing a senior board member at each organisation to lead on patient safety.

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